The prevalence of obesity and chronic diseases is increasing in industrialized countries. The Mediterranean diet is one of the healthiest dietary models that currently exist, and those countries following this pattern benefit from low rates of chronic diseases morbidity and high life expectancy. It successfully combines pleasant taste and healthy dietary habits, including high consumption of vegetables and fresh fruits.

Characteristics of the Mediterranean diet

Traditional Mediterranean dietary patterns are characterised by high intakes of plant foods such as fruits and vegetables, bread, cereals (primarily whole-grain), pulses and nuts. These foods are consumed in season and, for the most part, in fresh form, having undergone little or no processing. This enhances the availability and utilisation of the micronutrients and antioxidants they contain.

There is no single Mediterranean diet but rather there are as many eating patterns as there are Mediterranean countries. Despite the fact that the Mediterranean diet concept has gained popularity, not all countries bordering the Mediterranean have preserved the distinctive dietary patterns that were defined in the 1950’s. Children and adolescents are those with the most deteriorated Mediterranean diet profile. Changes in their diet include increased energy intake and increased consumption of foods with low nutrient density (soft drinks, candy, sweets, etc.). These changes have negatively impacted certain nutritional benefits characteristic of the diet: reduced antioxidant and vitamin intakes, increased proportions of saturated fatty acids, and decreased fibre consumption.

Fruit and vegetable intake in children

Epidemiologic evidence suggests that a high consumption of fruit and vegetables is related to a low risk of certain types of cancer, certain digestive diseases and cardiovascular diseases, among others. As a result, public health agencies recommend that people over the age of 2 years should consume at least 5 servings of fruits and vegetables per day. Nutrition education efforts should be directed towards children to establish healthy eating habits that will have beneficial effects in adulthood. This is because chronic diseases have been detected at early ages, and childhood may be the easiest time to learn healthy lifestyle behaviours.
Although consumption of fruits and vegetables among Europeans of all ages is lower than recommended, it is especially low for children and adolescents. There is a need for European children to achieve healthful eating habits to attain optimal growth and development and reduce the risk of chronic diseases. However, modern society has produced certain sociological changes, such as less time for food preparation, new products and new habits. The diets of most children do not meet the recommendations of the Food Guide Pyramid, especially for fruits and vegetables. This is important due to their content in minerals, vitamins, phytochemicals and dietary fibre. Choosing a variety of foods is thought to improve eating patterns by increasing exposure to a wider range of essential nutrients and other dietary components, including fibre and phytochemicals.

The consumption of fruit for breakfast, at least in some countries, is not very usual, and is even less in children and adolescents. For instance, a typical breakfast for Spanish children consist of milk with cocoa powder or soluble chocolate and sugar, a choice of either breakfast cereals, biscuits, bread, buns, croissants, etc. Only a few have orange juice or some kind of fruit. Regarding fruit preference, bananas and apples seem to be the fruit items preferred by Spanish children and young people, followed by oranges, strawberries and melon. Within the vegetable group, tomato sauce and salads, particularly lettuce and tomato salad, are the most commonly consumed items, followed by carrots.

Bioactive compounds in fruits and vegetables

Bioactive compounds are components of foods that influence physiological or cellular activities resulting in a beneficial health effect. It is important to note that bioactive compounds are not nutrients, and typically they occur in small amounts.

The presumed protective effect of fruits and vegetables is attributed to their high concentration of antioxidants. An antioxidant is a chemical substance that delays or prevents oxidation of a substrate. The production of oxidants (free radicals) is an event associated with aerobic metabolism. Inadequate antioxidant defences lead to oxidant-mediated diseases. Antioxidants inhibit oxidant formation, intercept oxidants and repair oxidant-induced injury Major dietary antioxidants are vitamin C, vitamin E, selenium, carotenoids, flavonoids, and other phenolic compounds. Antioxidants may counteract the adverse effects of oxidative stress and lead to improved immune function. The balance between free radicals and antioxidants is important for maintaining healthy body systems.

In conclusion, the diets of children and adolescents are undergoing important changes, which make them a priority target for nutrition interventions. Governments should take steps to prioritise cultivating, raising, producing, transporting and commercialising healthy foods, like fruits and vegetables.